Tears for tears

It brings saddened tears to my eyes when I hear beautiful empowering birth stories, that end with women still considering the option of caesarean section for their next birth, due to bad perineal (skin between vagina and anus) tearing. Why is perineal trauma sometimes the finale of what can be one of the most amazing experiences of a woman’s life? It just doesn’t seem fair.

My friend Kim, blogs about her life as a missionary in Johannesburg. Recently, on “kimlovesjozi“, she discussed her hopes and fears, in the lead up to her second birth. She outlined her thoughts about her birth choices, formulated somewhat by the perineal trauma she sustained from her first birth. I too, can empathise.

After my first birth I was left with quite a bad 2nd degree tear (1st degree involves tears only skin deep, 2nd is skin and muscle layers, 3rd is skin, muscle and anal sphincter and let’s not talk about 4th degree). I was bruised black and blue and couldn’t sit down properly for weeks. I did muse about whether a caesarean would be easier, but vaginal birth still came up trumps in my mind. I would prefer a few weeks of discomfort “down below” to having anaesthetic, having a major operation and a much bigger cut in my stomach, not to mention the weeks of recovery not being able to pick up my baby, cough or laugh, without pain. That’s just my opinion.

Don’t hear me say all caesareans are bad. Some people absolutely need them. I just believe there has to be a really good reason to risk all the associated morbidities.

I wasn’t scared about tearing (though I thought it was probably inevitable) in my second birth because I knew what to expect. I think people worry about feeling the tear when it happens. For the majority of people who tear, the sensation you feel is relief not extra pain. This is because the moment you tear is usually when you are the most stretched, so tearing releases the stretching feeling and then a millisecond later your baby is born and you’re consumed with feelings for your beautiful bundle. People also worry a lot about the actual stitching, but for me the bad thing about stitching was the local anaesthetic and even that only felt like a little bee sting. Nothing compared to the birth I’d just endured. I could only feel the actual stitching as a touch sensation, like if you pinch the skin on the back of your elbow.

Some women sustain very severe perineal tears and subsequent complications, such as incontinence or dyspariunia (pain on intercourse). I can understand why these women choose to have elective caesareans. However, if you sustain a bad tear but heal well and have no associated complications, there is hope for future births. I have personally known quite a few cases where women have even had 3rd degree tears in their first birth and then gone on to have intact perineums, or only very minor tears, with following births.

Fear associated with perineal trauma can grossly inhibit the progress of labour, particularly during second stage (beginning with full dilatation, ending with birth of baby). I was a bit nervous about tearing during my first birth, but I tried to maintain the mindset of “if it happens, it happens and I’ll deal with it then”. Fear of birth can also increase a woman’s experience of pain. I can testify to this; I coped with the pain of Levi’s birth until I stopped progressing, at which point I became fearful of the outcome of my planned home birth. From that point onwards my pain got exponentially worse. With Arlo’s birth, I had done a lot of work (seeing a psychologist and reading and practicing strategies from the “calmbirth” course notes) to prepare my mind for the possibility of feeling that extent of pain again. I’m not lying when I say that his birth truly did not hurt as much. The pain was bearable as I was working with it, not against it. I even enjoyed labour, strange as that may sound.

“Calmbirth” also talks about acknowledging that your body knows how to birth your baby the perfect way for you both. If you try and breathe through the contractions (also called waves or surges) instead of holding your breath and pushing, then your perineum will not be tense, will be allowed to stretch as it should and will be less likely to tear. Again this was true for me. Second time around I tried hard to breathe instead of holding my breath and pushing until I turned blue like my first birth. The pushing feeling is really intense so the only way I managed not to push was by blowing raspberries against the wall of the pool. The result was that I only got a very minor tear (where I had non-stretchy scar tissue) that only required 2 stitches.

My encouragement to all pregnant women aiming for a natural vaginal birth, whether you’ve had babies or not, with or without perineal trauma, is – preparation is the key. Prepare your body and mind with exercise, reading natural birth books and going to a childbirth course (like Calmbirth). Hopefully then you will learn about positioning, breathing techniques and pain management strategies to facilitate you to have a good and satisfying birth experience (with hopefully no perineal trauma!).

3 thoughts on “Tears for tears

  1. Holly

    Hi Naomi i have been reading all your blogs, but i cant read this one and not comment!!
    I am currently 37 weeks pregnant with bub no 2, and i am petrified by my upcoming birth.
    I had a traumatic birth with Jake, an episiotomy and 3rd degree tears after a natural drug free (except for gas) birth, with suction cap not working, then Jake coming out via forceps after 3 hours of being fully dialated and pushing! I also have Crohns disease, which the tear did not help in any way or form! I am not sure how many stitches i had as the doctor did 1 continueous stitch, but he was stitching for 45 minutes straight.
    Also when Jake was 3 months old i had to go in for an operation to fix some ‘proud skin’ that didnt heal properly after the stitches. So i had ALOT of trauma with my first birth.
    But i couldnt even consider a caesarian as an option with bub no 2, there was nothing like the feeling of knowing that i accomplished that by myself, no drugs to help, and delivered the most perfect little boy. I think the trauma of those first few months is nothing to having a scar on your belly forever, and 6 weeks of feeling so useless when your new baby needs you so badly!! I am absoloutely petrified of whats to come, and i am not looking forward to it, but i know it will all be worth it in no time at all. 🙂

    1. Naomi Post author

      Holly, you are an amazing woman! What you have endured and are yet still committed to birthing naturally is inspirational. Generally second babies come out much easier as your body has done it before, so I really hope your second birth is as healing of your trauma as mine was. If you’d like to write down your birth story, we could put it as a guest post. Sometimes it’s therapeutic to get it out there, just a thought, no pressure. Many blessings for your upcoming birth journey! Xx

  2. Bec

    I think the biggest fear of the birthing experience for me is the thought of tearing… I think in my mind it’s inevitable.
    I know part of the fear associated is knowing that my mum had arterial tearing in her first birth, obviously not very common (in that I’ve not heard of it from anyone else) and although (very) bad for mum at the time she went on to have me, her second, naturally.
    It’s nice to hear that the experience of the actual tearing in the scheme of things is generally more reliving then specifically painful, I think that starts to alleviate fears a little.
    I really hope that I don’t ever get to the point where the fear makes me want to have a ceaser, I feel like I’ve heard much more painful stories about the aftermarth of a reutine ceaser then tearing, but all that’s still to come for me. I’ll just need to keep reading, readying and processing.


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